In August 2004, South Africa officially sought to legally recognize the practice of traditional healers. Largely in response to the HIV/AIDS pandemic, and limited both by the number of practitioners and by patients’ access to treatment, biomedical practitioners looked toward the country’s traditional healers as important agents in the development of medical education and treatment. This collaboration has not been easy. The two medical cultures embrace different ideas about the body and the origin of illness, but they do share a history of commercial and ideological competition and different relations to state power. Healing Traditions: African Medicine, Cultural Exchange, and Competition in South Africa, 1820–1948 provides a long-overdue historical perspective to these interactions and an understanding that is vital for the development of medical strategies to effectively deal with South Africa’s healthcare challenges.
Between 1820 and 1948 traditional healers in Natal, South Africa, transformed themselves from politically powerful men and women who challenged colonial rule and law into successful entrepreneurs who competed for turf and patients with white biomedical doctors and pharmacists. To understand what is “traditional” about traditional medicine, Flint argues that we must consider the cultural actors and processes not commonly associated with African therapeutics: white biomedical practitioners, Indian healers, and the implementing of white rule.
Carefully crafted, well written, and powerfully argued, Flint’s analysis of the ways that indigenous medical knowledge and therapeutic practices were forged, contested, and transformed over two centuries is highly illuminating, as is her demonstration that many “traditional” practices changed over time. Her discussion of African and Indian medical encounters opens up a whole new way of thinking about the social basis of health and healing in South Africa. This important book will be core reading for classes and future scholarship on health and healing in Africa.
In this seminal collection of articles on health care in the Third World, sociological perspectives are applied to medical issues in revealing ways. Fourteen essays (all but two of which are original to this volume) examine the social production of health, disease, and systems of care throughout the developing world. The volume covers a range of areas—central Africa, Nigeria, Singapore, Taiwan, Indonesia, Nepal, China, United Arab Emirates, Oman, and Mexico—and a broad scope of topics, from emergency care, the AIDS epidemic, and women's health care, to public health programs and national health care policies.
Contributors address the central question of whether health systems in developing areas should emphasize the role of clinical medicine and individual physicians or community and preventive medical resources. The major health problems faced by these societies—inadequate sanitation, infectious disease, high infant-child mortality, and a lack of family planning—indicate the greater need for health educators and public health workers despite many poor nations' desire for Western doctors. Other topics that are examined include the process of seeking medical aid; the relationship between traditional and modern medicines; medical education, hospital care, and communication between doctors and patients in developing countries; and the relevance and application of sociology in Third World settings.
This volume seeks to draw attention to the significance of medical sociology for understanding Third World health problems and to show how examining developing societies may necessitate reframing or modifying some Western sociological notions. In addition, these essays stretch the boundaries of medical sociology to include Third World issues.
In this concise, straightforward analysis, Jost challenges the historical and theoretical assumptions on which the consumer-driven health care movement is based and reexamines the empirical evidence that it claims as support. He traces the histories of both private health insurance in the United States and the CDHC movement. The idea animating the drive for consumer-driven health care is that the fundamental problem with the American health care system is what economists call “moral hazard,” the risk that consumers overuse services for which they do not bear the cost. Jost reveals moral hazard as an inadequate explanation of the complex problems plaguing the American health care system, and he points to troubling legal and ethical issues raised by CDHC. He describes how other countries have achieved universal access to high-quality health care at lower cost, without relying extensively on cost sharing, and he concludes with a proposal for how the United States might do the same, incorporating aspects of CDHC while recognizing its limitations.
If we can decode the human genome and fashion working machines out of atoms, why can't we navigate the quagmire that is our health care system? In this important new book, Julius Richmond and Rashi Fein recount the fraught history of health care in America since the 1960s. After the advent of Medicare and Medicaid and with the progressive goal to make advances in medical care available to all, medical costs began their upward spiral. Cost control measures failed and led to the HMO revolution, turning patients into consumers and doctors into providers. The swelling ranks of Americans without any insurance at all dragged the United States to the bottom of the list of industrialized nations.
Over the last century medical education was also profoundly transformed into today's powerful triumvirate of academic medical centers, schools of medicine and public health, and research programs, all of which have shaped medical practice and medical care. The authors show how the promises of medical advances have not been matched either by financing or by delivery of care.
As a new crisis looms, and the existing patchwork of insurance is poised to unravel, American leaders must again take up the question of health care. This book brings the voice of reason and the promise of compromise to that debate.
Arguing that health care should be a human right rather than a commodity, the distinguished contributors to this volume call for a new social covenant establishing a right to a standard of health care consistent with society's level of resources. By linking rights with limits, they offer a framework for seeking national consensus on a cost-conscious standard of universal medical care. The authors identify the policy implications of recognizing and implementing such a right and develop specific criteria to measure the success of health care reform from a human rights perspective.
Health Care Reform also offers specific and timely criticism of managed competition and its offspring, the Clinton plan for health care reform. Because health care reform will inevitably be an ongoing process of assessment and revision—especially since managed competition has not been implemented elsewhere—this book will last beyond the moment by providing vital standards to guide the future evolution of the health care system.
The Health Care Safety Net in a Post-Reform World examines how national health care reform will impact safety net programs that serve low-income and uninsured patients. The “safety net” refers to the collection of hospitals, clinics, and doctors who treat disadvantaged people, including those without insurance, regardless of their ability to pay. Despite comprehensive national health care reform, over twenty million people will remain uninsured. And many of those who obtain insurance from reform will continue to face shortages of providers in their communities willing or able to serve them. As the demand for care grows with expanded insurance, so will the pressure on an overstretched safety net.
This book, with contributions from leading health care scholars, is the first comprehensive assessment of the safety net in over a decade. Rather than view health insurance and the health care safety net as alternatives to each other, it examines their potential to be complementary aspects of a broader effort to achieve equity and quality in health care access. It also considers whether the safety net can be improved and strengthened to a level that can provide truly universal access, both through expanded insurance and the creation of a well-integrated and reasonably supported network of direct health care access for the uninsured.
Seeing safety net institutions as key components of post-health care reform in the United States—as opposed to stop-gap measures or as part of the problem—is a bold idea. And as presented in this volume, it is an idea whose time has come.
The role of American hospital expansions in health disparities and medical apartheid
Health Colonialism considers how U.S. urban development policies contribute to the uneven and unjust distribution of health care in this country. Here, Shiloh Krupar investigates the racially inequitable effects of elite U.S. hospitals on their surrounding neighborhoods and their role in consolidating frontiers of land primed for redevelopment.
Naming this frontier “medical brownfields,” Krupar shows how hospitals leverage their domestic real estate empires to underwrite international prospecting for patients and overseas services and specialty clinics. Her pointed analysis reveals that decolonizing health care efforts must scrutinize the land practices of nonprofit medical institutions and the liberal foundations of medical apartheid perpetuated by globalizing American health care.
Contributors. Deborah A. Stone and Theodore R. Marmor, Judith Feder, Alice Sardell, Bruce C. Vladeck, Michael Lipsky and Marc A. Thibodeau, Daniel M. Fox, William E. McAuliffe, M. Gregg Bloche and Francine Cournos, Lawrence D. Brown, James A. Morrone
Public silence in policymaking can be deafening. When advocates for a disadvantaged group decline to speak up, not only are their concerns not recorded or acted upon, but also the collective strength of the unspoken argument is lessened—a situation that undermines the workings of deliberative democracy by reflecting only the concerns of more powerful interests.
But why do so many advocates remain silent on key issues they care about and how does that silence contribute to narrowly defined policies? What can individuals and organizations do to amplify their privately expressed concerns for policy change?
In Healthy Voices, Unhealthy Silence, Colleen M. Grogan and Michael K. Gusmano address these questions through the lens of state-level health care advocacy for the poor. They examine how representatives for the poor participate in an advisory board process by tying together existing studies; extensive interviews with key players; and an in-depth, first-hand look at the Connecticut Medicaid advisory board's deliberations during the managed care debate. Drawing on the concepts of deliberative democracy, agenda setting, and nonprofit advocacy, Grogan and Gusmano reveal the reasons behind advocates' often unexpected silence on major issues, assess how capable nonprofits are at affecting policy debates, and provide prescriptive advice for creating a participatory process that adequately addresses the health care concerns of the poor and dispossessed.
Though exploring specifically state-level health care advocacy for the poor, the lessons Grogan and Gusmano offer here are transferable across issue areas and levels of government. Public policy scholars, advocacy organizations, government workers, and students of government administration will be well-served by this significant study.
Malaria is an infectious disease like no other: it is a dynamic force of nature and Africa’s most deadly and debilitating malady. James C. McCann tells the story of malaria in human, narrative terms and explains the history and ecology of the disease through the science of landscape change. All malaria is local. Instead of examining the disease at global or continental scale, McCann investigates malaria’s adaptation and persistence in a single region, Ethiopia, over time and at several contrasting sites.
Malaria has evolved along with humankind and has adapted to even modern-day technological efforts to eradicate it or to control its movement. Insecticides, such as DDT, drug prophylaxis, development of experimental vaccines, and even molecular-level genetic manipulation have proven to be only temporary fixes. The failure of each stand-alone solution suggests the necessity of a comprehensive ecological understanding of malaria, its transmission, and its persistence, one that accepts its complexity and its local dynamism as fundamental features.
The story of this disease in Ethiopia includes heroes, heroines, witches, spirits—and a very clever insect—as well as the efforts of scientists in entomology, agroecology, parasitology, and epidemiology. Ethiopia is an ideal case for studying the historical human culture of illness, the dynamism of nature’s disease ecology, and its complexity within malaria.
This new collection of essays on HIV viruses spans disciplines to topple popular narratives about the origins of the AIDS pandemic and the impact of the disease on public health policy.
With a death toll in the tens of millions, the AIDS pandemic was one of the worst medical disasters of the past century. The disease was identified in 1981, at the height of miraculous postwar medical achievements, including effective antibiotics, breakthrough advances in heart surgery and transplantations, and cheap, safe vaccines—smallpox had been eradicated just a few years earlier. Arriving as they did during this era of confidence in modern medicine, the HIV epidemics shook the public’s faith in health science. Despite subsequent success in identifying, testing, and treating AIDS, the emergence of epidemics and outbreaks of Ebola, Zika, and the novel coronaviruses (SARS and COVID-19) are stark reminders that such confidence in modern medicine is not likely to be restored until the emergence of these viruses is better understood.
This collection combines the work of major social science and humanities scholars with that of virologists and epidemiologists to provide a broader understanding of the historical, social, and cultural circumstances that produced the pandemic. The authors argue that the emergence of the HIV viruses and their epidemic spread were not the result of a random mutation but rather broader new influences whose impact depended upon a combination of specific circumstances at different places and times. The viruses emerged and were transmitted according to population movement and urbanization, changes in sexual relations, new medical procedures, and war. In this way, the AIDS pandemic was not a chance natural occurrence, but a human-made disaster.
Essays by: Ernest M. Drucker, Tamara Giles-Vernick, Ch. Didier Gondola, Guillaume Lachenal, Amandine Lauro, Preston A. Marx, Stephanie Rupp, François Simon, Jorge Varanda
This first extensive study of the practice of blood transfusion in Africa traces the history of one of the most important therapies in modern medicine from the period of colonial rule to independence and the AIDS epidemic. The introduction of transfusion held great promise for improving health, but like most new medical practices, transfusion needed to be adapted to the needs of sub-Saharan Africa, for which there was no analogous treatment in traditional African medicine.
This otherwise beneficent medical procedure also created a “royal road” for microorganisms, and thus played a central part in the emergence of human immune viruses in epidemic form. As with more developed health care systems, blood transfusion practices in sub-Saharan Africa were incapable of detecting the emergence of HIV. As a result, given the wide use of transfusion, it became an important pathway for the initial spread of AIDS. Yet African health officials were not without means to understand and respond to the new danger, thanks to forty years of experience and a framework of appreciating long-standing health risks. The response to this risk, detailed in this book, yields important insight into the history of epidemics and HIV/AIDS.
Drawing on research from colonial-era governments, European Red Cross societies, independent African governments, and directly from health officers themselves, this book is the only historical study of the practice of blood transfusion in Africa.
WINNER, 2017 RACHEL CARSON PRIZE, SOCIETY FOR THE SOCIAL STUDIES OF SCIENCE
In 2002, Sierra Leone emerged from a decadelong civil war. Seeking international attention and development aid, its government faced a dilemma. Though devastated by conflict, Sierra Leone had a low prevalence of HIV. However, like most African countries, it stood to benefit from a large influx of foreign funds specifically targeted at HIV/AIDS prevention and care.
What Adia Benton chronicles in this ethnographically rich and often moving book is how one war-ravaged nation reoriented itself as a country suffering from HIV at the expense of other, more pressing health concerns. During her fieldwork in the capital, Freetown, a city of one million people, at least thirty NGOs administered internationally funded programs that included HIV/AIDS prevention and care. Benton probes why HIV exceptionalism—the idea that HIV is an exceptional disease requiring an exceptional response—continues to guide approaches to the epidemic worldwide and especially in Africa, even in low-prevalence settings.
In the fourth decade since the emergence of HIV/AIDS, many today are questioning whether the effort and money spent on this health crisis has in fact helped or exacerbated the problem. HIV Exceptionalism does this and more, asking, what are the unanticipated consequences that HIV/AIDS development programs engender?
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